The Bruce W. Carter VA Medical Center in Miami, where a nurse was implicated in the loss or theft of prescription drugs, according to a letter from the U.S. Department of Veterans Affairs to a Florida Congressman. The nurse was allowed to resign instead of being fired, but the VA is reporting to the nurse to the state licensing board for discipline. Roberto KoltunThe Miami Herald

The Bruce W. Carter VA Medical Center in Miami, where a nurse was implicated in the loss or theft of prescription drugs, according to a letter from the U.S. Department of Veterans Affairs to a Florida Congressman. The nurse was allowed to resign instead of being fired, but the VA is reporting to the nurse to the state licensing board for discipline. Roberto KoltunThe Miami Herald

Hundreds of doses of fentanyl and other powerful prescription drugs have been lost or stolen from five Florida Veterans Affairs hospitals and other facilities, including the Bruce W. Carter VA Medical Center in Miami, according to federal officials.

Many of the drugs were lost or stolen after being sent by mail to veterans, but at least two employees at Florida VA medical centers were implicated in the missing drugs — including a Miami VA medical center nurse who was allowed to resign instead of being fired.

The revelations were made in an April 13 letter from the federal Department of Veterans Affairs to U.S. Rep. Vern Buchanan of Florida, a Republican whose district in Manatee County reported one of the state’s highest rates of fentanyl-related deaths in 2015. Buchanan had asked the VA to explain the drug thefts in Florida, the types of narcotics that were missing and what the agency was doing to hold employees responsible.

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“The last thing Manatee County, and Florida, needs is more fentanyl on the street,” Buchanan said in a press release Monday. “VA leadership needs to make it crystal clear to its employees they will face serious repercussions for stealing deadly drugs.”

Over the past decade, Florida has experienced a spike in deaths caused by fentanyl, a potent and synthetic alternative to heroin, according to the Florida Department of Law Enforcement. The Miami Herald chronicled the rise of the synthetic drug in its Pipeline China series in 2015.

Deaths linked to fentanyl, which is often illegally imported from clandestine labs in China and Mexico, skyrocketed 310 percent in Miami-Dade and 100 percent in Broward, but dipped about 8 percent in Palm Beach in 2015, the most recent year documented in the FDLE report.

The last thing Manatee County, and Florida, needs is more fentanyl on the street.

U.S. Rep. Vern Buchanan of Florida, R-Sarasota

A spokesman for the Miami VA medical center said he could not identify the nurse implicated in the case due to an ongoing investigation. But he said that administrators ordered an immediate inquiry after another employee reported concerns about the nurse.

Shane Suzuki, director of public and congressional affairs for the Miami VA Healthcare System, said in a written statement that the investigation led to “the nurse being removed from direct patient care and eventually admitting to diverting fentanyl and resigning her position when faced with being fired.

“This case is still under review by the Department of Justice,” Suzuki added.

Like other VA medical centers, the Miami facility is required to count all controlled substances every 72 hours and to store those drugs under lock and key, with electronic controls that require two-factor authentication.

Since October, Suzuki said, “only two controlled substance orders have been confirmed missing out of the thousands of completed mail-out pharmacy orders” issued by the Miami VA medical center.

In the letter to Buchanan, the federal VA’s acting under secretary for health, Poonam Alaigh, a physician, said prescription drug losses affected five VA centers in Florida — in Bay Pines in Pinellas County, Miami, Orlando, Tampa and West Palm Beach.

The types of controlled substances that were lost or stolen included opioids, such as oxycodone, morphine and codeine; benzodiazepines, such as midazolam; and amphetamines, including dextroamphetamine.

Alaigh reported that about 30 veterans were affected by prescription drug losses in Florida, but she did not explain in the letter who the veterans were or how they were affected, an omission that Buchanan called “troubling” in his statement.

U.S. Sec. Veterans Affairs David Shulkin visited the Bruce W. Carter VA Medical Center in Miami in March, where he spoke about the need for greater accountability of VA employees and the agency’s efforts to reduce prescriptions of narcotics.

Roberto Koltun rkoltun@miamiherald.com

The VA under secretary said that “the overwhelming number” of drug losses at the VA occur after prescriptions have left the facilities and entered the mailing system to be delivered to veterans. Those cases are reported to the Drug Enforcement Administration for further investigation.

But drugs also have been lost or stolen inside Florida’s VA facilities.

As of 2016, there were five cases of drugs being lost inside Florida VA centers, according to the letter. Two of the cases involved Florida VA employees. In two other cases, the missing drugs were eventually found. In the fifth case, the VA was unable to identify a responsible individual.

One of the VA employees involved was a nurse at the Miami VA, who received a “proposed removal,” a notification the nurse was about to be fired. The nurse resigned instead of waiting to be fired, according to the letter. The VA did not identify the Miami employee, but noted that the agency is reporting the nurse to the Florida Board of Nursing, which licenses nurses.

The second Florida employee, who works at the Bay Pines VA Healthcare System, received a 14-day suspension for a single instance of a lost narcotic, according to the letter.

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